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Subject Area

Ophthalmology

Article Type

Original Study

Abstract

Objective The purpose of this study was to evaluate magnesium sulfate (MgSO4) or dexmedetomidine combined with bupivacaine versus bupivacaine for postoperative epidural analgesia in patients undergoing total knee replacement (TKR). Background Epidural analgesia after TKR is an effective widely used technique. Plain bupivacaine is one of the commonly used drugs. Several adjuvants are emerging to enhance its analgesic properties and decrease possible side effects. MgSO4 and dexmedetomidine are promising. Patients and methods This prospective randomized controlled study included 60 patients undergoing TKR who were randomized into three groups for postoperative epidural analgesia: group B bupivacaine, group BM bupivacaine plus MgSO4, and group BD bupivacaine plus dexmedetomidine. Patients received first dose in the postanesthetic care unit and top-up doses were administered if patients had visual analog score greater than 4. The three groups were compared as regards analgesic efficacy, hemodynamic stability, and possible complications. Results No statistically significant difference was found between the three groups as regards patient demographics (age, sex, and the American Society of Anesthesiologists score). Group BD showed superior analgesic criteria with onset at 8.25 ± 1.1 min versus 9.8 ± 1.5 min in group BM and 10.1 ± 1.3 min in group B (P = 0.0002). Earliest peak analgesic effect was noticed in group BD at 14.5 ± 1.2 min versus 16.5 ± 1.6 min in group BM and 16.3 ± 1.5 min in group B (P = 0.0003). Time to top-up dose was longest in group BD (230.4 ± 26.7 min) versus 283.6 ± 32.5 min in group BM and 362 ± 50.1 min in group B (P = 0.0001). Patients in the three groups were hemodynamically stable, apart from four patients in group BM who developed hypotension requiring support (P = 0.01). Conclusion Dexmedetomidine and MgSO4 are safe adjuvants to bupivacaine in post-TKR epidural analgesia. Dexmedetomidine has superior analgesic characters and hemodynamic stability.

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